Homocysteine and ischaemic heart disease in the Caerphilly cohort

Elevated circulating total homocyst(e)ine concentrations are associated wit h a higher prevalence of ischaemic heart disease (IHD). We utilized data fr om the Caerphilly Prospective Cohort Study to assess the predictive power o f the serum total homocyst(e)ine concentration for future IHD. Serum total homocyst(e)ine concentrations were measured in 2290 men in the Caerphilly c ohort, a representative population sample of men aged 50=64 years. During a 5-year follow-up period, 56 men suffered fatal IHD, 77 had a non-fatal myo cardial infarction, while 21 were found to have ECG evidence of myocardial infarction (MI) when examined at follow-up. The mean serum total homocyst(e )ine concentration in the total of 154 men who experienced an incident IHD event was 12.4 mu mol/l, whereas the 2136 men who experienced no such event had a mean level of 11.7 mu mol/l. The difference between these means, exa mined by logistic regression and standardising for the effects of differenc es in age, social class, smoking, BMI, diabetes, HDL-cholesterol and preval ent IHD is 0.47 mu mol/l (95% CI= - 0.13 to 1.11 mu mol/l). The mean differ ence for the 56 men who died, and whose death was attributed to IHD, is 0.8 1 mu mol/l (95% CI= -0.17 to 1.88 mu mol/l) after correction for confoundin g factors. Vitamin nutritional status and alcohol intake were significant n egative determinants of serum total homocyst(e)ine concentrations; the effe ct of alcohol is explained by the folic acid content of beer, which is the preferred alcoholic beverage in Caerphilly. It is concluded that the serum total homocyst(e)ine concentration is weakly predictive of IHD events, thou gh in the present data adjustments for other factors attenuated the relatio nship and it became not statistically significant (P > 0.05). (C) 1998 Publ ished by Elsevier Science Ireland Ltd. All rights reserved.